Community-Acquired Pneumonia (CAP) Pathway Background and Objectives CCommunity-Acquired Pneumonia (CAP) is one of the most common pediatric diagnoses, responsible for approximately 2 million outpatient visits and 124,000 hospitalizations annually. In 2011, the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America released a new practice guideline with evidence-based recommendations for the management of CAP in otherwise healthy infants and children. Due to decreasing S. pneumoniae resistance, there is less need for broad-spectrum antibiotics to treat CAP. The new guidelines reflect this change in antimicrobial resistance. There is also evidence to suggest the usage of procalcitonin and its role in determining antibiotic need, as well as the utility of MRSA nasal PCR to determine the need for MRSA coverage. The objectives of this pathway are to: The objectives of this pathway are to: Decrease variation in antibiotic usage Decrease unnecessary use of broad spectrum antibiotics Decrease unnecessary use of azithromycin Optimize ampicillin/amoxicillin dosing for local pneumococcal resistance Decrease antibiotic usage to shortest effective duration Algorithm Download CAP Pathway Algorithm – Updated March 17, 2022 Attention: There is currently a shortage of intravenous (IV) clindamycin and amoxicillin formulations. In the event of a shortage at your institution, Connecticut Children’s Infectious Diseases and Immunology and Antimicrobial Stewardship Program suggests the following: Intravenous (IV) Clindamycin Alternatives If your patient is able to effectively take oral medications, it is recommended to simply substitute with oral clindamycin at a similar dose, as oral clindamycin has very high bioavailability (i.e., > 90%). If being used due to penicillin allergy: If able to tolerate cephalosporins: ceftriaxone If unable to tolerate cephalosporins: levofloxacin If being used for anaerobic coverage in complicated pneumonia: ceftriaxone and metronidazole If allergic to cephalosporins, ampicillin/sulbactam (300-400 mg/kg/day divided every 6 hours) If being used for MRSA coverage: vancomycin or linezolid Amoxicillin Formulations Alternatives Amoxicillin in any available formulation: 90 mg/kg/day div 3 doses (max 1 g /dose) Clindamycin 40 mg/kg/day div 3 or 4 doses (max 1800 mg/day) Cefdinir 14 mg/kg/day div 2 doses (max 600 mg/day) Augmentin ES (600 mg/5 ml) 90 mg/kg/day div 2 doses (max 1 g/dose) If you have any questions on further alternatives or appropriateness of antibiotics, please call our Infectious Diseases and Immunology Department through the One Call Hotline at 1-833-PEDS-NOW to be connected with the On-Call physician. Quality Metrics Percentage of patient with pathway order set usage Percentage of patients with appropriate antibiotics per pathway recommendations Percent of patients with appropriate discharge antibiotics (prescriptions) Average duration (days) of antibiotic coverage (inpatient and discharge antibiotic combined) Average length of stay (days) Percentage patients who had a CBC, who also had procalcitonin drawn Percentage of patients with a procalcitonin level ≤0.25 who receive an antibiotic Percentage of patients with negative MRSA PCR, and vancomycin or linezolid discontinued Educational Module Download CAP Educational Module – Updated March 17, 2022 Key References: Bradley JS, Byington CL, Shah SS, et al. The management of community-aquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Disease Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011 Oct;53(7):e25-76. Newman RE, Hedican EB, Herigo JC, Williams DD, Williams AR, Newland JG. Impact of a Guideline on Management of Children Hospitalized With Community-Acquired Pneumonia. 2012 Mar;129(3):e597-604. Pathway Contacts Jennifer Girotto, PharmD Grace Hong, APRN Ilana Waynik, MD Disclaimer The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case. View all Clinical Pathways >
